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        <p>插一个豆瓣成型片的内容吧。<br>1.使用方法<br>没找到说明书，从网上找了个。<a target="_blank" rel="noopener" href="http://blog.sina.com.cn/s/blog_15b77898f0102w15p.html">http://blog.sina.com.cn/s/blog_15b77898f0102w15p.html</a><br>①用钳子撑开固位环，要确认已经牢牢夹住。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0032-qb5-dbcxp/01.jpg"><br>②放置固位环进行分牙，环的脚放入邻间隙（颊侧或舌侧），环体朝向近中或者远中均可，如果放置近中，环体可将手指放上做支撑点。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0032-qb5-dbcxp/02.jpg"><br>③去腐备洞，带着圆环，一边分牙，一边去腐备洞型。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0032-qb5-dbcxp/03.jpg"><br>④选择合适成型片，调整其形状。一般用手指轻轻揉一揉，调整其形态配合牙形。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0032-qb5-dbcxp/04.jpg"><br>⑤放置成型片，用持针器或者镊子来夹持成型片，调整其位置，使其与牙体紧密贴合。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0032-qb5-dbcxp/05.jpg"><br>⑥用邻间楔固定成型片密合龈缘，注意邻间隙楔是用来关闭龈缘空隙的。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0032-qb5-dbcxp/06.jpg"><br>⑦放置圆环，注意：圆环的脚要放置在成型片和楔子之间。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0032-qb5-dbcxp/07.jpg"><br>⑧接触点的处理，轻轻推拉使其与牙体更加密合。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0032-qb5-dbcxp/08.jpg"><br>⑨椭圆环的联合使用，如果遇到MOD洞型，圆环太小，可以配合较大椭圆环放在远中，环体都朝向近中。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0032-qb5-dbcxp/09.jpg"><br>⑩双圆环的使用，如果修复MOD洞时，一定要使用两圆环时，一个环体朝向近中，一个环体朝向远中。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0032-qb5-dbcxp/10.jpg"><br>2.龋病相关的书上都没有这东西，查下文献吧。<br>①黎耀荣，周禹雄，刘瑜容.Ⅱ类洞龈壁位置对Palodent重建邻接关系影响的数字模型研究.新医学 2014,45(12):801-807.<br>体外研究，结论是二类洞龈壁位置可对Palodent重建邻接关系形成显著影响。<br>②赵伟鹏.Palodent V3修复磨牙临面缺损的临床疗效观察.中国实用医药2017年,12(2):60-62.<br>临床随机对照实验，样本量160颗邻面（原文写成临面了）缺损磨牙，分别用Palodent V3和传统成型片充填，修复后6个月和1年复诊，对比效果。<br>实验组修复后6个月和1年成功率分别为97.4%和94.3%，对照组为33.3%，27.9%，差异有统计学意义。<br>Palodent成形系统由AlvinMeyer博士1956年发明。<br>修复成功标准：美国公共卫生署(USPHS)修复体临床评价标准。<br>以Palodent为代表的分段式成形系统是直接树脂充填修复Ⅱ类缺损的一种主流技术，备洞时即利用弹力环分牙，成型片预制为接近后牙邻面形态的弧形，再用楔子封闭龈间隙后，成型片由弹力环固定于窝洞一侧的龈壁处，这时成型片的冠方仍可根据需要调整外形；这样更容易形成良好的后牙邻面形态和邻接触关系。而Palodent V3成形系统在Palodent的基础上进行了改良，主要有：①楔形护罩分牙备洞，可以保护邻牙接触区，防止备洞过程中损伤邻牙；②豆瓣成形片设计为更接近后牙邻面形态的弧形；③设计成V型楔子，可以堆叠，使封闭更为严密，并且 V型设计接近牙龈的形态，减少了对牙龈的损伤。<br>（数据存疑，这传统成型片修复成功率也太低了！）<br>③张德梅，解用江，阎雷.Palodent成形片系统在Ⅱ类洞树脂修复中的临床应用.中国美容医学 2013,22(17):1798-1800.<br>也是临床试验，检测指标是悬突，边缘嵴形态，外展隙形态，用牙线检查。问卷调查患者舒适度。结论也是豆瓣成型片优于传统成型片。<br>④钟珊. Palodent分段成型片系统的优点及椅旁助疗.护士进修杂志，2006,21(12):1148.<br>Palodent分段成型片系统由Bitine环和成型片构成，它保持了良好的邻面接触，使接触点保持在自然的位置，充填后不会造成食物嵌塞。它同时具有良好的可塑性，可以与牙齿有更紧密的吻合，更好的边缘连接。它具有最小的楔入，本身重量很轻，因为没有传统笨重的成型片夹那样有造成割裂牙龈组织的危险，可以让患者更舒适。它有更好的咬合面楔隙，并且可以从颊侧或舌侧轻松拆除，不会破坏刚充填好的修复体。它无需把成型片套到非治疗牙的邻面，更容易拆除，使用方便快捷。该装置适合目前任何修补材料的应用。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0032-qb5-dbcxp/11.jpg"><br>⑤张莉.Palodent邻面修复系统充填中四手操作的护理要点及体会.内蒙古医学杂志,2012,44(14):121-123.<br>Palodent成型片类型：标准型：适合绝大部分牙齿的修复，厚度=0.051mm；袖珍型：适合儿童、青少年，萌出不全的后牙、老年患者，厚度=0.038mm；加长型：适合于比较大的修复，年长的、牙龈退缩或牙体暴露过多者，厚度=0.051mm。<br>⑥陈洪，何静，张鹏恩.大尺寸豆瓣成型片修复老年磨牙邻面龋.中国组织工程研究,2016,20(21):3137-3142.<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0032-qb5-dbcxp/12.jpg"><br>⑦M.Peumans,B.Van Meerbeek, K.Asscherickx, et al. Do condensable composites help to achieve better proximal contacts? Dental Materials 17(2001)533-541.<br>比较各种树脂和成型系统对邻面邻接关系恢复的情况，就成型片来说，Palodent在形成可预期的紧密邻接区方面表现最好。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0032-qb5-dbcxp/13.jpg"><br>⑧Eva Wirsching, Bas A.C. Loomans, Bernd Klaiber, et al. Influence of matrix systems on proximal contact tightness of 2- and 3-surface posterior composite restorations in vivo. Journal of dentistry 39(2011):386-390.<br>研究不同成形系统对二类洞恢复邻接关系的影响。相比使用传统的成型系统，使用阶段成形系统进行后牙二类洞充填有更高的邻接紧密程度。<br>⑨Shu-Fen Chuang, Kuo-Chih Su, Chun-Hsiang Wang, et al. Morphological analysis of proximal contacts in class Ⅱ direct restorations with 3D image reconstruction. Journal of dentistry 39(2011):448-456.<br>用3D图像重建来对树脂充填的二类洞的邻接恢复情况进行形态学分析。用不同的树脂和成型系统来做试验，试验结果：节段式成型系统从外观上看，有解剖轮廓，但是在中央是凹陷的。而常规的成型系统形成的轮廓是平坦的。节段式成型系统改善了邻接的紧密程度。3D图像重建显示节段式成型系统形成了更深和更宽的表面凹度(surface concavity)。结果显示尽管节段成型系统能改进接触紧密度，它也会造成接触凹度形成悬突。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0032-qb5-dbcxp/14.jpg"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0032-qb5-dbcxp/15.jpg"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0032-qb5-dbcxp/16.jpg"><br>总结：豆瓣成型片与传统成型片相比能形成更好的邻接接触，我使用过一次，很失败。圆环的脚要放在成型片与楔子之间。遇到病例再试试。</p>
<p>我发文章的三个地方，欢迎大家在朋友圈等地方分享，欢迎点“在看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的知乎文章地址： <a target="_blank" rel="noopener" href="https://www.zhihu.com/people/zhao-you-min/posts">https://www.zhihu.com/people/zhao-you-min/posts</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/other/wx.jpg"></p>

      
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